Zhonghua wei zhong bing ji jiu yi xue · 2025
[Prognostic differences between patients with endogenous and exogenous acute respiratory distress syndrome and the dynamic predictive value of cumulative fluid balance].
СтатьяНаблюдательное исследованиеАннотация на английскомНазвание и аннотация: Перевод пока не подготовлен
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Chen Yanni, An Xing, Ma Xigang
Аннотация
OBJECTIVE: To investigate the differences in prognosis and to analyze the predictive value of cumulative fluid balance at different time points for 28-day mortality in patients with endogenous versus exogenous acute respiratory distress syndrome (ARDS).
METHODS: In this retrospective observational study, patients diagnosed with ARDS according to the Berlin definition (2012) and admitted to the department of critical care medicine of the General Hospital of Ningxia Medical University between August 2020 and February 2025 were enrolled. Patient demographics, laboratory parameters, blood gas analyses, tidal volume, positive end expiratory pressure (PEEP), norepinephrine dosage, and disease severity scores were collected. The 28-day ventilator-free days, ICU length of stay, and 28-day survival status were recorded. The cumulative fluid balance was calculated at 3, 5, and 7 days after ICU admission. Based on etiology, patients were categorized into endogenous and exogenous ARDS groups. The Kaplan-Meier method was used to compare 28-day survival rates, and receiver operator characteristic curves (ROC curves) were plotted to assess the predictive value of cumulative fluid balance at 3, 5, and 7 days for 28-day mortality in both groups.
RESULTS: A total of 218 ARDS patients were included, comprising 100 with endogenous ARDS and 118 with exogenous ARDS. Significant differences were observed between the two groups in age, heart rate, activated partial thromboplastin time (APTT), total bilirubin (TBil), C-reactive protein (CRP), procalcitonin (PCT), pH, PEEP, lactate, bicarbonate, and norepinephrine dosage (all P < 0.05). The ICU length of stay was significantly longer in the endogenous ARDS group than in the exogenous ARDS group [days: 11.50 (6.00, 18.00) vs. 8.00 (4.00, 17.25), P < 0.05]. No significant differences were found in 28-day ventilator-free days or 28-day mortality between the two groups. The Kaplan-Meier analysis showed no significant difference in the 28-day survival rate [41.0% (41/100) vs. 54.2% (64/118), P > 0.05]. ROC curve analysis indicated that the cumulative fluid balance at 3, 5, and 7 days had a higher predictive value for 28-day mortality in the exogenous ARDS group compared to the endogenous ARDS group. The most significant predictive performance was observed for the 7-day cumulative fluid balance in the exogenous ARDS group [area under the curve (AUC) = 0.754]. At a cut-off value of 9.42 mL/kg, the sensitivity was 75.93% and the specificity was 71.87%.
CONCLUSIONS: Patients with endogenous ARDS had a significantly longer ICU stay than those with exogenous ARDS. The cumulative fluid balance at 3, 5, and 7 days after ICU admission demonstrated a higher predictive value for 28-day mortality in patients with exogenous ARDS.
METHODS: In this retrospective observational study, patients diagnosed with ARDS according to the Berlin definition (2012) and admitted to the department of critical care medicine of the General Hospital of Ningxia Medical University between August 2020 and February 2025 were enrolled. Patient demographics, laboratory parameters, blood gas analyses, tidal volume, positive end expiratory pressure (PEEP), norepinephrine dosage, and disease severity scores were collected. The 28-day ventilator-free days, ICU length of stay, and 28-day survival status were recorded. The cumulative fluid balance was calculated at 3, 5, and 7 days after ICU admission. Based on etiology, patients were categorized into endogenous and exogenous ARDS groups. The Kaplan-Meier method was used to compare 28-day survival rates, and receiver operator characteristic curves (ROC curves) were plotted to assess the predictive value of cumulative fluid balance at 3, 5, and 7 days for 28-day mortality in both groups.
RESULTS: A total of 218 ARDS patients were included, comprising 100 with endogenous ARDS and 118 with exogenous ARDS. Significant differences were observed between the two groups in age, heart rate, activated partial thromboplastin time (APTT), total bilirubin (TBil), C-reactive protein (CRP), procalcitonin (PCT), pH, PEEP, lactate, bicarbonate, and norepinephrine dosage (all P < 0.05). The ICU length of stay was significantly longer in the endogenous ARDS group than in the exogenous ARDS group [days: 11.50 (6.00, 18.00) vs. 8.00 (4.00, 17.25), P < 0.05]. No significant differences were found in 28-day ventilator-free days or 28-day mortality between the two groups. The Kaplan-Meier analysis showed no significant difference in the 28-day survival rate [41.0% (41/100) vs. 54.2% (64/118), P > 0.05]. ROC curve analysis indicated that the cumulative fluid balance at 3, 5, and 7 days had a higher predictive value for 28-day mortality in the exogenous ARDS group compared to the endogenous ARDS group. The most significant predictive performance was observed for the 7-day cumulative fluid balance in the exogenous ARDS group [area under the curve (AUC) = 0.754]. At a cut-off value of 9.42 mL/kg, the sensitivity was 75.93% and the specificity was 71.87%.
CONCLUSIONS: Patients with endogenous ARDS had a significantly longer ICU stay than those with exogenous ARDS. The cumulative fluid balance at 3, 5, and 7 days after ICU admission demonstrated a higher predictive value for 28-day mortality in patients with exogenous ARDS.